Flashcards in Managing Upper Extremities Deck (46)
Which bones are broken in a Boxer’s fracture?
Which bones are broken in a Colles Fracture?
a fracture of the lower end of the radius in the wrist with a characteristic backward displacement of the hand (distal radius fracture)
What sensory distribution is disturbed with radial nerve palsy?
Sensory deficit: Loss of sensation in lateral arm, posterior forearm (extensors), the radial half of dorsum of hand, and dorsal aspect of digits 1 and ½ of 2 (see photo below)-excluding their nail beds
Numbness and tingling in radial half of dorsum of hand
What motor distribution is disturbed with radial nerve palsy?
Major muscles lost: triceps; ECRL (extensor carpi radialis longus); ECRB (extensor carpi radialis brevis); ECU (extensor carpi ulnaris), EDC (extensor digitorum communis); EPL (extensor pollicis longus); APL (abductor pollicis longus)
Loss of elbow extension, wrist extension, MCP extension of IF-SF, thumb extension and abduction
List five symptoms of carpal tunnel syndrome.
Numbness and/or tingling in the thumb, middle finger, index, ½ of ring
Weakness in thumb
Trouble gripping objects
What is the most effective provocative test for carpal tunnel syndrome? How do you conduct the test?
1. Phalen’s test – fully flex wrists with dorsum of hands pressing against each other. Positive is the client reports tingling, in median nerve distribution within 1 minute.
2. Tinel’s sign: Tap on the inside of client’s wrist over the median nerve. Positive is client feels tingling, numbness, "pins and needles," or a mild "electrical shock" sensation in hand when wrist it tapped
3. Compression test – the examiner places pressure over the median nerve in the carpal tunnel for up to 30 seconds. Positive if tingling occurs in median n. distribution.
List six elements of conservative treatment for carpal tunnel syndrome.
Night wrist immobilization orthosis – wrist 0-20 degrees of extension
Median nerve gliding exercises
Tendon gliding exercises
Injections to carpal canal
What motor and sensory distribution is disturbed by ulnar neuropathy?
Things that are affected by ulnar nerve: flexor carpi ulnaris, FDP (flexor digitorum profundus) of ring and small finger, adductor pollicis, deep head of FPB (flexor pollicis brevis), abductor/opponens/flexor digiti minimi, 3rd and 4th lumbricals
Numbness in ring and small finger
What is the elbow flexion test for ulnar neuropathy?
It is a test to determine whether or not a person has cubital tunnel syndrome, which is compression of the ulnar nerve at the elbow
Fully flex elbows with wrists fully extended for 3-5 minutes...test result is positive if tingling is reported in the ulnar nerve distribution of the forearm and hand (ulnar ring finger and small finger)
What is the difference between a Swan Neck and a Boutonniere contracture?
Swan Neck: hyperextension of the PIP joint and flexion of the DIP joint with possible flexion of the MCP joint; function compromised by inability to flex the PIP joint with loss of the ability to make a fist or hold small objects
Boutonniere: flexion of the PIP joint and hyperextension of the DIP joint; function of the finger is compromised by inability to straighten the finger and the loss of flexion at the fingertip for pinching
What is the Finkelstein test and what is it used to detect?
Finkelstein's test is used to diagnose De Quervain's tenosynovitis in people who have wrist pain. To perform the test, the examining physician or therapist grasps the thumb and ulnar deviates the hand sharply, as shown in the image. If sharp pain occurs along the distal radius (top of forearm, close to wrist; see image), de Quervain's tenosynovitis is likely
What is Froment’s test and what is it used to detect?
Detects: Ulnar Nerve Weakness/ulnar nerve palsy
Positive if thumb IP flexes
Ask the client to hold a piece of paper between the thumb and clenched fist. Flexion of the thumb with resistance indicates significant adductor pollicis weakness (supplied by the ulnar nerve).
List five changes in appearance that you look for in evaluating an injured hand.
What is the DASH? What does it assess?
DASH Outcome Measure = Disabilities of the Arm, Shoulder, and Hand
The DASH and Quick DASH assesses pain and function and ability to perform ADL tasks (optional work and performing arts/sports modules)
Explain the 3-color concept in wound assessment.
Red = Granulated. Ideal color. Protect properly healing wounds. NO debridement. Keep wound moist to protect new cells, cover with sterile gauze, and non-adherent dressings
Yellow = Fibrinous, “slough.” Devitalized tissue. Possible infection… high exudate (drainage). Debride and use wet to moist dressing
Black = necrotic tissue or “eschar”, non-viable tissue, inhibits healing process. Debride – sharp, mechanical, chemical. Wet-moist dressing, sterile gauze, and non-adherent dressings
List seven signs of skin infection.
Describe two ways to measure limb edema.
Volumetrics = “gold standard” measures hand volume with displaced water (accurate to within 10 ml). Immerse hand in a full volumeter and catch displaced water to measure.
Circumferential Measurements = quick and easy to administer, measure with a flexible measuring tape, not as accurate, but used when volumetrics are contraindicated (e.g. open wounds…)
List 5 techniques that may be used to manage edema.
1. Elevate hand above the heart
2. Use of hand for ADLs within limits prescribed by the physician
3. MEM – manual edema mobilization (light massage in specific patterns)
4. AROM – maximum available ROM performed firmly (Also with uninvolved joints like the elbow and shoulder)
5. Compression – light compression using coban wraps of the affected area or light compression garments can help control swelling, especially at night
List 3 fine motor dexterity tests
1. Jebson (Taylor) Hand Function Test: provides a broad sampling of hand function
2. The Purdue Pegboard: measures fingertip dexterity & gross motor function; used to obtain baseline data & measure progress; can also be used as a treatment activity
3. The Minnesota Rate of Manipulation Test: measures eye-hand coordination & arm-hand dexterity; great treatment for FMC, in-hand manipulation, and eye-hand coordination
4. Rolyan 9-Hole Peg Test: FM coordination and eye-hand coordination; tests ability to follow simple commands
Describe three strategies to improve digital mobility for a patient with a “stiff hand” after a hand injury.
active and passive ROM
What are the components of a thorough sensory evaluation?
1. WEST Monofilament Test: patient positioned palm up and vision occluded; thinnest first; apply filament just enough so that it bends (or with thicker filaments, just enough pressure to blanch the skin); work proximal to distal; 1-3 correct responses is affirmative
2. 2-Point Discrimination: test only finger tips; apply to point of skin blanching; 7-10 responses is affirmative
3. Vibration Testing: Purpose to determine frequency response of mechanoreceptor ends organs; not as reliable
4. Hot/Cold Testing: warm and cool water
List indications for joint mobilization activities.
Joint dysfunction: PROM
List contraindications for joint mobilization activities.
Malignancy, Rheumatoid collagen necrosis, fracture, joint ankylosis, acute inflammatory, infective arthritis
List relative contraindications/precautions for joint mobilization.
osteoarthritis, hypermobility, ligamentous rupture, bone disease, fractures, neurological involvement,, vascular disorders, acute inflammation, joint replacements, pt inability to relax
-degenerative joint disease
-Classified as primary or secondary
primary: no known cause and may be localized (i.e. involvement of one or two joints) or generalized (i.e. diffuse involvement generally including three or more joints)
secondary: can be related to identifiable cause, such as trauma, anatomic abnormalities, infection, or aseptic necrosis
increases with age, 50 years old more common in females
usually develops slowly over period of years
Disease process: noninflammatory (may have some secondary inflammation from joint damage), characterized by cartilage destruction
Joints commonly affected are neck, spine, hips, knees, MTPs, DIPs, PIP’s, thumb CMCs
characterized by joint pain, stiffness, tenderness, limited movement, variable degrees of local inflammation, and crepitus
Morning stiffness usually lasts 30 minutes or less
Explain rheumatoid arthritis
autoimmune inflammatory response in the joint lining of a genetically predisposed host
usually ages 40-60 (onset can take place at any age though); 3:1 female-to-male ratio
usually develops suddenly within weeks or months
has systemic features like fever, fatigue, malaise, extra-articular manifestations
disease process: inflammatory, characterized by synovitis
joints most commonly affected are neck, jaw, hips, knees, ankles, MTPs, shoulders, elbows, wrists, PIPs, MCPs, thumb joints
Morning stiffness usually lasts at least 1 hour, often 2 or more
Inflammation of the synovial membrane that lines the joint capsule of diarthrodial joints (the function of normal synovial tissue is to secrete a clear fluid into the joint for the purpose of lubrication)
In RA- synovial cells produce matrix-degrading enzymes that destroy cartilage and bone; joint swelling results from excessive production of synovial fluid, enlargement of the synovium, and thickening of the joint capsule
Know the characteristics of the 3 types of joint deformity most often seen in OA.
Deformity of the small joints of the hand will develop within the first two years in more than 10%
Wrist radial deviation, MP ulnar deviation, and swan neck and boutonniere deformities of the digits are the joint changes most often seen
Joint changes, or deformities, can result from a variety of mechanisms, including joint immobility, destruction of cartilage and bone, and alterations in muscles, tendons, and ligaments.
Tenosynovitis (inflammation of the tendon sheath) and the presence of nodules within the flexor tendon sheaths can cause trigger finger
Patients may also have symptoms of nerve compression of the median or ulnar nerves at the wrist; tendon rupture may also be seen
What are the four stages of functional ability with RA as defined by the American College of Rheumatology?
Class I: completely able to perform usual activities of daily living (self-care, vocational, and avocational)
Class II: able to perform usual self care and vocational activities, but limited in avocational activities
Class III: able to perform usual self-care activities, but limited in vocational and avocational activities
Class IV: limited in ability to perform usual self-care, vocational, and avocational activities